O arquétipo do mestre-aprendiz - Considerações sobre a vivência / The master-apprentice archetype ­ Considerations about the experience / El arquetipo del maestro-aprendiz ­ Consideraciones sobre la vivencia

A partir de sua experiência como professora e como aluna, a autora tece reflexões sobre o campo de interação constelado pelo arquétipo do mestre-aprendiz. O "Teatro Arquetípico", ou "Mitodrama", é apresentado tal como é formulado por sua autora, tal como tem sido realizado numa disciplina do curso de graduação em Psicologia, e tal como pode ser enriquecido em alguns aspectos por contribuições de Erich Neumann sobre a fase do self corporal e de Juana Elbein dos Santos sobre o sistema Nagô. O artigo faz ainda algumas considerações sobre as relações e as diferenças entre a psicoterapia e a pedagogia, e termina por ressaltar a importância da palavra que "rasga a fantasia", permitindo o fluir da elaboração simbólica embasada no vivido.

Drawing from her experience as both a professor and a student, the author reflects upon the field of interaction constellated by the master-apprentice archetype. The "Archetypal Theater", or "Mythodrama", is presented as it is formulated by its author, as it is implemented in a course within the undergraduate Psychology program at the University of Sao Paulo, and as it can be enriched in certain aspects by contributions from Erich Neumann regarding the phase of the body-self and from Juana Elbein dos Santos regarding the Nagô system. The article also offers some considerations on the relationships and differences between psychotherapy and pedagogy and concludes by emphasizing the importance of the words, which allow the flow of symbolic elaboration grounded on experience.

A partir de su experiencia como profesora y como alumna, la autora teje reflexiones sobre el campo de interacción constelado por el arquetipo del maestro-aprendiz. El "Teatro Arquetípico", o "Mitodrama", se presenta tal como es formulado por su autora, tal como ha sido realizado en una disciplina del curso de graduación en Psicología, y tal como puede ser enriquecido en algunos aspectos por contribuciones de Erich Neumann sobre la fase del self corporal y de Juana Elbein dos Santos sobre el sistema Nagô. El artículo hace aún algunas consideraciones sobre las relaciones y diferencias entre la psicoterapia y la pedagogía, y termina por resaltar la importancia de la palabra que "rasga la fantasia", permitiendo el fluir de la elaboración simb6lica basada en lo vivido.

Retorno a actividades académicas universitarias presenciales: síntesis bibliográfica de las medidas de bioseguridad más eficaces / Return to face-to-face university academic activities: Bibliographical synthesis of the most effective biosecurity measures

Introducción:La pandemia provocada por la COVID-19 ha causado un gran impacto en la edu-cación. Actualmente se afrontan los retos del retorno progresivo a las actividades educativas.Objetivo: Determinar las medidas de mayor impacto en un contexto de retorno progresivo a las actividades presenciales en interiores. Material y métodos: Síntesis de información publicada, mediante la implementación de pa-labras claves en la búsqueda (return, biosecurity, vaccination, COVID-19, universities, mask, ventilation, fomites, body temperature, crowding, antibodies) en plataformas virtuales como: Pubmed, Google scholar, Elsevier que sustente la información de la aplicación de medidas de bioseguridad que permitan el retorno a clases.Resultados: El uso correcto de mascarillas, higiene frecuente, distanciamiento social, el respeto del aforo, y ventilación de ambientes cerrados son medidas indispensables que deben ser controladas por un comité para reducir la probabilidad de contagio. La medición de temperatura corporal como tamizaje de casos es cuestionable, son necesarias medidas regulatorias en el transporte de vehículos y terminales, los fómites en superficies juegan un papel mínimo en la transmisión de la COVID-19, las pruebas rápidas son una opción práctica y de confianza para el rastreo de casos activos y los vacunados deben seguir adoptando medidas de bioseguridad.Conclusiones: La factibilidad del retorno a clases presenciales depende de factores exter-nos: movilidad y transporte de estudiantes y su situación económica, e internos: implemen-tación y cumplimiento de las medidas ya mencionadas, lo cual se logrará con un adecuado manejo de los recursos económicos asignados a las universidades.

Introduction: The pandemic caused by the COVID-19 has had a great impact on education. Currently, the challenges of the progressive return to face-to-face educational activities are being faced.Objective: To determine the measures that have the greatest impact in a context of progres-sive return to classroom activities indoors.Material and methods: Synthesis of published information, through the implementation of keywords in the search (return, biosecurity, vaccination, COVID-19, universities, mask, ven-tilation, fomites, body temperature, crowding, antibodies) in virtual platforms such: Pubmed, google scholar, Elsevier that supports the information on the application of biosafety measu-res that allow the return to face-to-face classes.Results: The correct use of masks, frequent hygiene, social distancing, capacity respect, and the ventilation of closed environments are essential measures that must be controlled by a committee to reduce the probability of contagion, the measurement of body temperature as screening of cases is questionable, regulatory measures are necessary in the transport of vehicles and terminals, fomites on surfaces play a minimal role in the transmission of the COVID-19, rapid tests are a practical and reliable option for tracking active cases, and vacci-nated population should continue to adopt biosafety measures.Conclusions: The feasibility of returning to in-person classes depends on external factors: mobility and transportation of students and their economic situation, and internal factors: im-plementation and fulfillment with the afore mentioned measures, which will be achieved with an adequate management of the economic resources assigned to the universities.

Efficacy of personal protective equipment to prevent environmental infection of COVID-19 among healthcare workers: a systematic review

BACKGROUND@#Healthcare workers (HCWs) employed personal protective equipment (PPE) during the COVID-19 pandemic, crucial to protecting themselves from infection. To highlight the efficacy of PPE in preventing environmental infection among HCWs, a systematic review was conducted in line with PRISMA guidance.@*METHODS@#A search of the PubMed and Web of Science databases was conducted from January 2019 to April 2021 using pre-defined search terms. Articles were screened by three researchers. The approved papers were read in full and included in this review if relevance was mutually agreed upon. Data were extracted by study design and types of PPEs.@*RESULTS@#47 of 108 identified studies met the inclusion criteria, with seven reviews and meta-analyses, seven cohort, nine case-control, fifteen cross-sectional studies, four before and after, four case series, and one modeling studies. Wearing PPE offered COVID-19 protection in HCWs but required adequate training. Wearing surgical masks provided improved protection over cloth masks, while the benefit of powered air-purifying respirators is less clear, as are individual gowns, gloves, and/or face shields.@*CONCLUSIONS@#Wearing PPE, especially facial masks, is necessary among HCWs, while training in proper use of PPE is also important to prevent COVID-19 infection.

Effects of face mask on pulse rate and blood oxygenation

ABSTRACT Objective The World Health Organization and Centers for Disease Control and Prevention recommend the use of face masks in public. This study aimed to evaluate the effects of face masks on pulse rate and partial blood oxygen saturation in patients without cardiorespiratory disorders. Methods A total of 150 volunteers of both sexes were divided into three groups (n=50) according to age (children, young adults, and older adults). The partial blood oxygen saturation and pulse rate were measured for each volunteer using a digital oximeter while wearing a facial mask and remaining at rest. The masks were removed for two minutes, and partial blood oxygen saturation and pulse rate were remeasured. The materials and types of masks used were recorded. The t -test for paired samples was used to compare the mean values obtained before and after removing the masks. Results The most frequently used mask was a two-layered cloth (64.7%). A decrease in pulse rate was observed after removing the face mask in males, particularly in children (p=0.006) and young adults (p=0.034). Partial blood oxygen saturation levels increased in young adult males after mask removal (p=0.01). Conclusion The two-layer cotton tissue face masks are associated with a higher pulse rate and reduced arterial blood oxygen saturation without associated clinical disorders, mainly in adult men with a lower tolerance to breathing and ear discomfort.

Reporter's communicative performance, while wearing face masks, during the COVID-19 pandemic / Performance comunicativa dos repórteres com o uso de máscara facial durante a pandemia da COVID-19

ABSTRACT Purpose: to identify the impact of wearing protective face masks on reporters' communicative performance during the COVID-19 pandemic and verify whether there was an association between these aspects. Methods: a quantitative, descriptive, cross-sectional study with a sample of 32 reporters (16 females and 16 males) who worked, during the pandemic. Most participants had a bachelor's degree (n = 28; 87.5%). The sample's mean age was 35.09 years (SD = 9.41), and they had been working in the area for a mean of 10.09 years (SD = 7.62). Reporters answered an online form with 26 questions, developed by the researchers, on their self-perception of voice and communicative performance when wearing a mask, during the pandemic. Data were descriptively analyzed, and the chi-square test was applied with the Statistical Package for the Social Sciences 20 (SPSS). Results: most reporters (n = 20; 62.5%) classified their voices and speech articulation as good (n = 19; 59.4%) and reported difficulties hearing and/or being heard by interviewees in noisy places and perceived their voices were lower, muffled, or with a low volume (n = 28; 87.5%). Also, 22 (68.8%) reported having to speak louder than usually to be heard. Lastly, the questions on reporters' communicative performance were associated with wearing masks while reporting. Conclusion: wearing protective face masks, during reportage, negatively impacted reporters and was associated with their communicative performance.

RESUMO Objetivo: identificar o impacto do uso de máscara de proteção facial na performance comunicativa dos repórteres durante a pandemia da COVID-19, bem como verificar se existe associação entre esses aspectos. Métodos: trata-se de um estudo transversal, de caráter descritivo, com abordagem quantitativa. Participaram 32 repórteres que atuaram durante a pandemia, sendo 16 do sexo feminino e 16 do sexo masculino. A maioria dos participantes tinha ensino superior (n = 28; 87,5%). A amostra apresentou média de idade de 35,09 anos (DP = 9,41) e tempo de atuação na área de 10,09 anos (DP = 7,62). Os repórteres responderam a um formulário online composto por 26 questões, elaborado pelos próprios pesquisadores, sobre a autopercepção vocal e performance comunicativa do repórter com o uso de máscara durante a pandemia. Foi realizada análise descritiva dos dados e aplicado o teste Qui-quadrado por meio do software Statistical Package for Social Sciences 20 (SPSS). Resultados: a maioria dos repórteres (n = 20; 62,5%) classificou sua voz e articulação de fala como boas (n = 19; 59,4%). A maioria dos participantes relatou sentir dificuldade de ouvir e/ou ser ouvido pelo entrevistado em locais com ruído e perceber a sua voz mais baixa, com pouco volume ou abafada (n= 28; 87,5%), bem como 22 (68,8%) relataram ter que falar mais alto do que o normal para ser ouvido. Por fim, verificou-se a presença de associações entre as questões sobre a performance comunicativa dos repórteres e o uso de máscaras durante as reportagens. Conclusão: os repórteres apresentaram impactos negativos com uso das máscaras de proteção facial durante as reportagens, bem como verificou-se associação entre o uso destas com a performance comunicativa.

Effects on communication due to face mask use: an integrative review / Efectos en la comunicación por el uso de cubrebocas: revisión integradora / Efeitos na comunicação em razão de uso de máscara facial: revisão integrativa

ABSTRACT Objectives: to integrate evidence from studies on auditory perceptual and speech production effects in communication situations with face mask use. Methods: an integrative literature review, in MEDLINE, Cochrane Library and Embase databases. The guiding question was: what effects on communication (perceptual-auditory and speech production) occur with face mask use? Results: searches in electronic databases resulted in 1,478 studies and filtering resulted in 29 final studies. Conclusions: mask use has effects on communication, both in perception and speech production, factors that are also related to quality of life, stress and socio-emotional factors. These data can impact on indicators and alerts in favor of adopting strategies to manage mask use, involving speech production and perception when wearing a mask in health services.

RESUMEN Objetivos: integrar evidencias de estudios sobre efectos perceptuales auditivos y de producción del habla en situaciones de comunicación con el uso de mascarilla facial. Métodos: revisión integrativa de la literatura, en las bases de datos MEDLINE, Cochrane Library y Embase. La pregunta orientadora fue: ¿qué efectos en la comunicación (perceptivo-auditiva y producción del habla) se producen con el uso de mascarillas? Resultados: las búsquedas en bases de datos electrónicas dieron como resultado 1.478 estudios y el filtrado dio como resultado 29 estudios finales. Conclusiones: el uso de mascarillas tiene efectos en la comunicación, tanto en la percepción como en la producción del habla, factores que también se relacionan con la calidad de vida, el estrés y factores socioemocionales. Estos datos pueden impactar en indicadores y alertas a favor de la adopción de estrategias para gestionar el uso de mascarillas, involucrando la producción y percepción del habla al usar mascarilla en los servicios de salud.

RESUMO Objetivos: integrar evidências de estudos sobre efeitos perceptivos auditivos e de produção de fala em situações de comunicação com o uso de máscara facial. Métodos: revisão integrativa da literatura, nas bases MEDLINE, Cochrane Library e Embase. O questionamento direcionador foi: quais efeitos na comunicação (perceptivo-auditivos e de produção de fala) ocorrem com o uso de máscaras faciais? Resultados: as buscas nas bases de dados eletrônicas resultaram em 1.478 estudos, e a filtragem culminou em 29 estudos finais. Conclusões: o uso de máscaras traz efeitos na comunicação, tanto na percepção quanto na produção da fala, fatores ademais relacionados à qualidade de vida, estresse e socioemocionais. Esses dados podem impactar em indicadores e alertas em prol da adoção de estratégias ao manejo de uso de máscaras, envolvendo a produção e percepção de fala em ocasião de uso de máscara nos serviços de saúde.

Produção e validação de cartilha digital sobre uso de máscaras no contexto pandêmico da COVID-19 / Production and validation of a digital booklet on the use of masks in the COVID-19 pandemic context / Producción y validación de un folleto digital sobre el uso de mascarillas en el contexto pandémico de la COVID-19

Objetivo: produzir e validar cartilha digital sobre o uso de máscaras no contexto da pandemia da COVID-19. Método: estudo metodológico realizado via online, nas etapas: busca dos temas e estudo teórico, elaboração da cartilha digital, validação por especialistas, adequação após avaliação dos especialistas, validação pelo público-alvo (população em geral), adequação após avaliação pelo público-alvo e disponibilização da cartilha. Para validação, considerou-se o Índice de Validade de Conteúdo (IVC) satisfatório ≥0,70. Resultados: cartilha "Uso seguro de máscaras: como proteger a mim e ao outro" foi produzida e validada por 20 especialistas e 19 representantes do público-alvo, com IVC médio global de 0,99. Os itens foram validados quanto ao conteúdo e aparência, apresentando índices entre 0,94 e 1,00. Conclusão: a cartilha é válida e adequada, avaliada como uma tecnologia educacional motivadora e de fácil compreensão sobre o uso de máscaras, contribuindo para a ampliação do conhecimento da população no contexto pandêmico.

Objective: To produce and validate a digital booklet on the use of masks in the COVID-19 pandemic context. Method: An online methodological study was conducted, comprising the following steps: search for themes and theoretical study, creation of the digital booklet, expert validation, adjustments following expert validation, validation by the target audience (general population), adjustments following validation by the target audience, and publication. Validation was based on a satisfactory Content Validity Index (CVI) of ≥0.70. Results: The booklet "Safe Use of Masks: How to Protect Myself and Others" was produced and validated by 20 specialists and 19 target audience members, with an overall average CVI of 0.99. The content and appearance were validated with indices ranging between 0.94 and 1.00. Conclusion: The booklet is valid and appropriate, assessed as a motivating educational technology that is easily understandable regarding mask use, contributing to increasing the population's knowledge in the pandemic context.

Objetivo: Producir y validar un folleto digital sobre el uso de máscaras en la pandemia COVID-19. Método: Estudio metodológico online, con búsqueda de temas y estudio teórico, elaboración del folleto digital, validación por especialistas, ajustes tras la evaluación de especialistas, validación por público (población en general), ajustes tras la evaluación del público y publicación. La validación fue basada en Índice de Validez de Contenido (IVC) ≥0,70. Resultados: El folleto "Uso seguro de máscaras: cómo protegerme a mí y a los demás" fue producido y validado por 20 especialistas y 19 representantes del público, con un IVC promedio de 0,99. Los elementos fueron validados en cuanto a contenido y apariencia, presentando índices entre 0,94 y 1,00. Conclusión: El folleto es válido y apropiado, evaluado como una tecnología educativa motivadora y clara sobre el uso de máscaras, contribuyendo a ampliar el conocimiento de la población en la pandemia.

Bidding against each other: local procurement of personal protective equipment in the context of decentralization and high socio-economic inequality / Compitiendo entre sí: adquisición local de equipos de protección personal en un contexto de descentralización y alta desigualdad socioeconómica / Concursos públicos: aquisição local de equipamentos de proteção individual no contexto de descentralização e elevada desigualdade socioeconômica

Abstract Under the influence of fiscal federalism and government decentralization theories, a significant part of health systems around the world confronted the COVID-19 pandemic after being shaped or re-shaped by processes of devolution from central to local governments. Procurement of key supplies is one of the components that operate in a decentralized manner, forcing local governments to compete against each other. This was the origin of what has been called the "bidding wars" between subnational governments at the beginning of the pandemic response. These wars led to centralization policies in the United States, the United Kingdom, and the European Union. Yet, less is known about cases from the Global South. By analyzing the procurement of Personal Protective Equipment (PPE) in the 320 Chilean municipalities in charge of primary health, this research provides evidence of the impacts of horizontal government competition on the ability to procure key supplies. In Chile, during the 2020 response to the pandemic, richer municipalities were able to procure more face masks per population, while economies of scale rewarded bigger purchases with lower prices. The authors support the theoretical notion of "concurrency" as a concept that adds nuances to the centralization-decentralization debate. In Chile, for instance, while testing and tracking required decentralization, PPE purchases could have probably benefited from centralization in order to avoid reproducing territorial inequalities.

Resumen Bajo la influencia del federalismo fiscal y las teorías de la descentralización gubernamental, una parte importante de los sistemas de salud de todo el mundo enfrentaron la pandemia de COVID-19 después de haber sido moldeados o reformados por procesos de transferencia de poderes de los gobiernos centrales a los locales. La adquisición de suministros clave es uno de los componentes que opera de manera descentralizada, lo que obliga a los gobiernos locales a competir entre sí. Este fue el origen de lo que se ha llamado las "guerras de licitaciones" entre gobiernos subnacionales al comienzo de la respuesta a la pandemia. Estas guerras llevaron a políticas de centralización en Estados Unidos, Reino Unido y la Unión Europea. Sin embargo, se sabe menos sobre los casos del sur global. Al analizar la adquisición de Equipos de Protección Personal (EPP) en 320 municipios chilenos encargados de la atención primaria de salud, esta investigación proporciona evidencia de los impactos de la competencia gubernamental horizontal en la capacidad de adquirir suministros clave. En Chile, durante la respuesta a la pandemia de 2020, los municipios más ricos pudieron adquirir más mascarillas por habitante, generándose con ello economías de escala que les permitieron acceder a precios más bajos, a diferencia de aquellos municipios con menores recursos. Los autores apoyan la noción teórica de "concurrencia" como un concepto que añade matices al debate sobre centralización-descentralización. En Chile, por ejemplo, si bien el testeo y la trazabilidad de casos SARS-CoV-2 requerían la descentralización de dichas funciones, las compras de EPP probablemente podrían haberse beneficiado de la centralización de los procesos de adquisición para evitar la reproducción de desigualdades territoriales.

Resumo Sob a influência do federalismo fiscal e das teorias de descentralização governamental, uma parte significativa dos sistemas de saúde em todo o mundo enfrentou a pandemia da COVID-19 depois de terem sido moldados ou remodelados por processos de transferência dos governos centrais para os governos locais. A aquisição de suprimentos essenciais é um dos componentes que operam de forma descentralizada, forçando os governos locais a competir entre si. Esta foi a origem do que foi chamado de "guerras de licitações" entre governos subnacionais no início da resposta à pandemia. Essas guerras levaram a políticas de centralização nos Estados Unidos, no Reino Unido e na União Europeia. No entanto, sabe-se menos sobre os casos do Sul Global. Ao analisar a aquisição de Equipamentos de Proteção Individual (EPI) nos 320 municípios chilenos responsáveis pela saúde primária, esta pesquisa fornece evidências dos impactos da competição governamental horizontal na capacidade de adquirir suprimentos essenciais. No Chile, durante a resposta à pandemia de 2020, os municípios mais ricos conseguiram adquirir mais máscaras faciais por população, enquanto as economias de escala recompensaram compras maiores com preços mais baixos. Os autores apoiam a noção teórica de simultaneidade como um conceito que acrescenta nuances ao debate centralização-descentralização. No Chile, por exemplo, embora os testes e o acompanhamento exigissem a descentralização, as compras de EPI poderiam provavelmente ter beneficiado da centralização, a fim de evitar a reprodução de desigualdades territoriais.

Motivos para o uso das máscaras no brasil durante a pandemia da covid-19

Objetivo: Analisar os motivos relacionados ao uso de máscaras entre a população brasileira durante a pandemia da COVID-19. Material e Método: Estudo transversal realizado entre abril e maio de 2020 e 2021, através de um formulário online composto por informações sociodemográficas e a Versão Brasileira da Reason of Using Face Mask Scale. Para caracterização sociodemográfica dos participantes, utilizou-se análise estatística descritiva com medidas de frequência absoluta, relativa e de dispersão. Para testar a normalidade dos dados utilizou-se o teste de Kolmogorov-Smirnov. Para comparação da pontuação foram adotados testes de hipóteses Mann-Whitney e Kruskal-Wallis. Todos os aspectos éticos foram contemplados. Resultados: Participaram do estudo 25.132 indivíduos, sendo a maioria do sexo feminino 18.453 (73,4%), solteiros 13.960 (55,5%), com idade média de 33 anos (DP= 12,7). A média da pontuação geral dos motivos atribuídos ao uso de máscaras dos participantes foi de 32,2 (DP= 3,8; mínimo= 13 e máximo= 46), sendo os principais motivos a suscetibilidade percebidas, severidade percebidas, benefícios percebidos, dicas para ação e barreiras percebidas. Conclusões: A pontuação geral para as razões para o uso do equipamento foi maior em 2021 quando comparada em 2020, sendo maior entre as mulheres, os jovens e indivíduos com renda superior a 7 salários mínimos.

Objective: To analyze the reasons related to the use of masks among the Brazilian population during the COVID-19 pandemic. Materials and Methods: Quantitative cross-sectional study carried out in Brazil during April and May 2020 and 2021, using an online form consisting of sociodemographic information and the Brazilian version of the Reason of Using Face Mask Scale. Descriptive statistics were used to characterize the sociodemographic data of the participants, using absolute and relative frequency, as well as dispersion measures. The Kolmogorov-Smirnov test was used to test the normality of the data. Mann-Whitney and Kruskal-Wallis hypothesis tests were used to compare outcomes. All ethical aspects were considered. Results: A total of 25,132 individuals participated in the study, the majority of whom were female 18,453 (73.4%), single 13,960 (55.5%), with a mean age of 33 years (SD=12.7). The average overall score of the reasons given by participants for using masks was 32.2 (SD=3.8; minimum=13 and maximum=46). The main reasons were susceptibility perceived, severity perceived, benefits perceived, advice to take action and perceived barriers. Conclusions: The overall score for reasons for using equipment was higher in 2021 than in 2020, and was higher among women, young people, and individuals with incomes above 7 minimum wages.

Objetivo: Analizar los motivos relacionados al uso de máscaras entre la población brasileña durante la pandemia de COVID-19. Material y Método: Estudio transversal cuantitativo realizado en Brasil durante abril y mayo de 2020 y 2021; se llevó a cabo con un formulario en línea compuesto por informaciones sociodemográficas y la Versión Brasileña de Reason of Using Face Mask Scale. Se utilizaron estadísticas descriptivas para caracterizar los datos sociodemográficos de los participantes, utilizando medidas de frecuencia absoluta y relativa y de dispersión. Se utilizó la prueba de Kolmogorov-Smirnov para comprobar la normalidad de los datos. Para comparar puntuaciones se adoptaron las pruebas de hipótesis de Mann-Whitney y Kruskal-Wallis. Se cubrieron todos los aspectos éticos. Resultados: Un total de 25,132 personas participaron de la investigación, siendo la mayoría mujeres 18.453 (73,4%), solteras 13.960 (55,5%), con una edad media de 33 años (DE= 12,7). La puntuación global media de los motivos atribuidos al uso de mascarillas por los participantes fue de 32,2 (DP= 3,8; mínimo= 13 y máximo= 46). Las principales razones fueron la susceptibilidad percibida, la severidad percibida, los beneficios percibidos, los consejos para la acción y las barreras percibidas. Conclusiones: La puntuación general de las razones para la utilización del equipamiento fue más alta en 2021 en comparación con 2020, siendo mayor entre las mujeres, los jóvenes y las personas con ingresos superiores a 7 salarios mínimos.

Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis / Eficácia do uso de máscaras durante o surto de COVID-19 em estudos de coorte e caso-controle: uma revisão sistemática e meta-análise

ABSTRACT Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = −0.21 (95% CI, −0.34 to −0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

RESUMO Objetivo: Avaliar a eficácia do uso de máscaras na prevenção da infecção por COVID-19. Métodos: Revisão sistemática e meta-análise de estudos de coorte e caso-controle, considerando o melhor nível de evidência disponível. Bancos de dados eletrônicos (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials e ClinicalTrials.gov) foram pesquisados para identificar estudos que avaliassem a eficácia do uso de máscaras em comparação com ausência de seu uso durante a pandemia de COVID-19. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane risk of bias e Grading of Recommendations Assessment, Development, and Evaluation. Resultados: Dos 1.028 estudos identificados, 9 preencheram os critérios de inclusão (2 estudos de coorte e 7 estudos de caso-controle) e foram incluídos na análise. A meta-análise usando apenas estudos de coorte mostrou diferenças estatisticamente significativas: o uso de máscara de tecido diminuiu 21% [(risk difference = −0,21 (IC 95%: −0,34 a −0,07); I2 = 0%; p = 0,002] o risco de infecção por COVID-19, mas a qualidade da evidência foi baixa. Em relação aos estudos caso-controle, o uso de máscara cirúrgica reduziu a chance de infecção por COVID-19 [OR = 0,51 (IC 95%: 0,37-0,70); I2 = 47%; p = 0,0001], assim como o uso de máscara respiratória N95 [OR = 0,31 (IC 95%: 0,20-0,49); I2 = 0%; p = 0,00001], ambos com baixa qualidade de evidência. Conclusões: Nesta revisão sistemática com meta-análise, demonstramos a eficácia do uso de máscaras na prevenção da infecção por SARS-CoV-2 independentemente do tipo de máscara (máscara cirúrgica descartável, máscaras comuns, incluindo máscaras de tecido, ou respiradores N95), embora os estudos avaliados apresentassem evidências de baixa qualidade e vieses importantes.

Effects and safety of facemask use on healthy adults during exercise: a systematic review and meta-analysis protocol

BACKGROUND@#Facemasks are used to minimize SARS-CoV-2 spread during the COVID-19 pandemic. However, facemask use during exercise is associated with possible adverse effects.@*OBJECTIVES@#To compare the effects of facemask use vs. non-facemask use on subjective responses, COVID- 19 incidence, and physiologic changes in healthy adults during exercise. @*METHODS@#The systematic review (PROSPERO registration number: CRD42022296247) will follow the PRISMA-P guidelines and use electronic databases Science Direct, PubMed, Google Scholar, Herdin, and EbscoHost. This will cover randomized parallel groups or randomized crossover studies investigating tolerability, physiologic effects, and the impact on SARS-COV2 incidence of commercially-available cloth, surgical, or FFR/N95 facemasks compared to no-facemask conditions during exercise among healthy adults, including studies published from the earliest date to January 31, 2022. Outcomes of interest will be facemask tolerability in 10 domains of comfort and objective cardiopulmonary, gas exchange, and metabolic responses. Mean differences (MD) or standardized mean differences (SMD) with a 95% confidence interval (CI) will be calculated overall and for subgroups using RevMan software (version 5.4.1). Pooled and subgroup estimates will be calculated using random-effects meta-analysis. The chi-squared test, I2 statistics, and visual analysis will assess heterogeneity. The GRADEpro will determine the certainty of the level of evidence. @*EXPECTED RESULTS@#An evidence-based recommendation using GRADE on the changes attributed to facemask use during exercise will be available. This will be useful for organizations when developing appropriate guidelines for exercising while mitigating the risk of SARS-CoV-2 transmission. Future researchers may use this study when redesigning comfortable facemasks without compromising filtration capability.

Median effective dose of alfentanil combined with propofol inhibiting responses to laryngeal mask airway insertion in children / 中华麻醉学杂志

Objective:To determine the median effective dose(ED 50) of alfentanil combined with propofol inhibiting responses to the laryngeal mask airway(LMA) insertion in children. Methods:American Society of Anesthesiologists Physical Status classification Ⅰ children, aged 6-10 yr, with body mass index of 18-24 kg/m 2, undergoing facial skin pigmented nevus resection, were selected. Propofol(target plasma concentration 3 μg/ml) was given by the target-controlled infusion, alfentanil was intravenously injected, 2 min later LMA was inserted, and anesthesia was maintained with 2%-3% sevoflurane until the end of surgery. The dose of alfentanil was determined by the up-and-down sequential method, the initial dose of alfentanil was 15 μg/kg, when the response to LMA insertion was positive/negative, the dose of alfentanil increased/decreased by 1 μg/kg in the next case. The LMA insertion response was defined as swallowing, bucking, body movement occurred during insertion of the LMA, and this process was repeated until 7th turning points appeared. The ED 50 and 95% confidence interval of alfentanil combined with propofol inhibiting responses to LMA insertion in children were calculated using probit method. Results:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion was 13.18(95% confidence interval 12.43-13.79) μg/kg in children. Conclusions:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion is 13.18 μg/kg in children.

Quinta arremetida de COVID-19 y el uso de mascarillas en espacios abiertos y cerrados / Fifth peak of COVID-19 and use of masks in open and enclosed spaces

Introduction: COVID-19 pandemic requires permanent adaptations in management depending on the epidemiological situation. Objective: To analyze the epidemiological behavior of COVID-19 in Cali (Colombia) after ending the face mask mandate in open and enclosed spaces between March 1 and July 11 of 2022. Materials and methods: An observational descriptive study of COVID-19 cases and cumulative incidence (CI) for 7 days with two temporary milestones: refusal of the obligatory use of face masks in open and enclosed environments, using data published by the National Institute of Health. The temporary tendency was evaluated with the Mann-Kendall non parametric test. Results: Differences were found between the first and second milestone; 922 cases in 75 days vs. 12,037 in 59 days; Tau=-0.22 vs. 0.57, S=-608 vs. 968, Var(S)=47,574.66 versus 233,280.66; Sen slope=-0.10 (IC95%: -0.18 and -0.03) versus 7.39 (IC95%: 5.23 and 8.88). After the second milestone, the CI increased with a positive tendency (S=23, p=0.006). Conclusions: The significant increases of COVID-19 cases and the CI coincided with the ending of the face mask mandate in enclosed spaces. Therefore, it is advisable to return to the use of face masks in enclosed spaces, strengthen infodemic management, promote vaccination, and improve natural ventilation.

Introducción: La pandemia COVID-19 demanda permanentes adaptaciones en la gestión según la situación epidemiológica. Objetivo: Analizar el comportamiento epidemiológico de COVID-19 en Cali (Colombia) post levantamiento de obligatoriedad de usar mascarillas en ambientes abiertos y cerrados, entre marzo 1 y julio 11/2022. Materiales y métodos: Estudio observacional descriptivo de casos de COVID-19 e incidencia acumulada (IA) para 7 días, con dos hitos temporales: desistimiento del uso mandatorio de mascarillas en ambientes abiertos y cerrados, usando datos publicados por el Instituto Nacional de Salud. Se evaluó la tendencia temporal con la prueba no paramétrica Mann-Kendall. Resultados: Se demostraron diferencias entre el primer y segundo hito: 922 casos en 75 días versus 12.037 en 59 días; Tau=-0,22 versus 0,57, S=-608 versus 968, Var(S)=47.574,66 versus 233.280,66; pendiente de Sen=-0,10 (IC95%: -0,18 y -0,03) versus 7,39 (IC95%: 5,23 y 8,88). Luego del segundo hito, la IA aumentó con tendencia positiva (S=23, p=0,006). Conclusiones: El aumento significativo de casos de COVID-19 y de IA coincidió con el levantamiento de la medida de usar mascarillas en espacios cerrados. Por tanto, se apoya el regresar al uso de mascarillas en espacios cerrados, reforzar la gestión infodémica, promover la vacunación y acrecentar la ventilación natural.

Bonding through the mask

The appearance of healthcare professionals and their interaction with patients has always been the scaffolding of the relationship between the caregiver and patient. The Covid-19 pandemic has challenged this with its need for masking and distancing. The duty bound frontline worker in the midst of the personal crisis brought about by this pandemic has undergone hitherto unknown experiences described here.

Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva / Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

RESUMO Objetivo: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. Métodos: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. Resultados: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01). O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). Conclusão: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Traducción y validez de la Escala de creencias sobre el uso de mascarillas para prevenir el contagio de la COVID-19 / Translation and validity of the Scale of beliefs about the use of masks to prevent the spread of COVID-19

RESUMEN Introducción: El uso de la mascarilla es indispensable para reducir la propagación de la COVID-19, pero, un porcentaje importante de personas se rehúsan a su uso. Es posible que las creencias jueguen un rol sustancial en la aceptación o rechazo de su uso. Sin embargo, se carece de una escala para evaluar las creencias sobre el uso de mascarillas para prevenir el contagio de la COVID-19. Objetivo: Traducir y determinar las evidencias de validez, de estructura interna y confiabilidad del autoinforme de creencias sobre el uso de las mascarillas. Métodos: El autoinforme de creencias sobre el uso de las mascarillas fue administrado a 1 218 personas de diferentes provincias del Perú (Medad = 27,4 años, DE = 12,6), elegidas de forma no probabilística. El instrumento fue sometido a un proceso de doble traducción del inglés al español y viceversa; además, mediante el programa Proyecto Jamovi versión 1.6, se determinó la estructura interna con análisis factorial (exploratorio y confirmatorio) y finalmente se estimó la confiabilidad. Resultados: El análisis factorial exploratorio identificó cuatro factores emergentes que explicaron el 53,7 % de la varianza. El modelo fue verificado y obtuvo índices de ajuste aceptables (χ² = 154 gl = 46; p < 0,01; CFI = 0,96; TLI = 0,942; RMSEA = 0,602). Además, se apreciaron cargas factoriales estandarizadas mayores a 0,30. Conclusión: La versión en español del autoinforme de creencias sobre el uso de las mascarillas muestra evidencias de validez, de estructura y confiabilidad por consistencia interna adecuadas.

ABSTRACT Introduction: The use of a mask is essential to reduce the spread of COVID-19, however, a significant percentage of people refuse to use it. Beliefs may play an important role in accepting or rejecting their use. Objective: To translate and determine the evidence of validity of internal structure and reliability of the self-report of beliefs about the use of masks. Methods: The self-report of beliefs about the use of masks was administered to 1218 people from different provinces of Peru (M age = 27,4 years, SD = 12,6), chosen in a non-probabilistic way. The instrument was subjected to a process of double translation from English to Spanish and vice versa; In addition, using the Jamovi Project version 1.6 program, the internal structure was determined with factor analysis (exploratory and confirmatory), and finally reliability was estimated. Results: The exploratory factor analysis identified four emerging factors that explained 53.7% of the variance. The model was verified and obtained acceptable fit indices (χ² = 154 gl = 46; p < 0,01; CFI = 0,96; TLI = 0,942; RMSEA = 0,602). In addition, standardized factor loadings greater than 0,30 were observed. Conclusions: The Spanish version of the self-report of beliefs about the use of masks shows evidence of validity of structure and reliability due to adequate internal consistency.

Assessment of dry eye disease in N95 versus surgical face mask wearers during COVID-19

Purpose: Investigating the effect of different face masks on dry eye disease (DED) among healthcare workers during the COVID?19 pandemic. Methods: This was a comparative, cross?sectional study. Participants were included into two groups: group 1 (n = 30) wore surgical masks, and group 2 (n = 30) wore N95 masks with face shields. Demographic and ocular surface disease index questionnaires (OSDI) were performed. In addition, Tear break?up time (TBUT), corneal and conjunctival fluorescein staining, and meibography to assess meibomian gland loss (MGL) were performed on all participants. Independent T?test was used to compare continuous parameters and Chi?square test for categorical variables. The relationship between continuous variables was tested using bivariate Pearson correlation. Results: Sixty healthcare workers participated in this study (36 females and 24 males). The mean (±SD) age of the surgical mask and N95 groups was 35.33 (±14.94) and 36.63 (±10.64) years, respectively. Both masks caused dryness according to TBUT, MGL, and OSDI scores. DED per DEWS II definition was observed in 14 (46.7%) and 16 (53.3%) patients in groups 1 and 2, respectively. Comparing the two groups, N95 mask caused significantly more dryness according to TBUT (P = 0.042) and fluorescein staining (P = 0.038 for the right eye and P = 0.015 for the left eye). Conclusion: Physicians should be aware of the potential dry eye signs secondary to face mask wear during the COVID?19 pandemic. Further attention should be taken in patients who suffer from preexisting dry eye syndrome and in patients who undergo intraocular operations

SPECIAL ARTICLE COVID-19: Safety for the Rhinologist in the Age of COVID-19: Mask Use, Nasal Corticosteroids, Saline Irrigation, and Endoscopic Procedures - Literature Review

Abstract Introduction Coronavirus disease 2019 (COVID-19) has claimed millions of lives. Adequate protection of the professionals involved in patient care is essential in the battle against this disease. However, there is much uncertainty involving safety-relarted topics that are of particular interest to the rhinologist in the context of COVID-19. Objective To evaluate the current evidence regarding three safety-related topics: mask and respirator use, performance of nasal endoscopic procedures, and use of topical nasal and intranasal medications (saline irrigation and nasal corticosteroids). Methods A literature review was performed on the PubMed, Scopus, and Cochrane databases, with standardized search queries for each of the three topics of interest. Results In total, 13 articles on mask use, 6 articles on the safety of nasal corticosteroids, 6 articles on the safety of nasal endoscopic procedures, and 1 article on nasal irrigation with saline solution were included in the final analysis. Conclusion N95 respirators are essential for the adequate protection of otolaryngologists. If reuse is necessary, physical methods of sterilization must be employed. No evidence was found to contraindicate the use of nasal corticosteroids, whether acute (in the management of sinonasal inflammatory conditions) or continued (in patients who use them chronically). Nasal irrigation with saline solution apparently does not increase the risk in the context of COVID-19. Nasal endoscopic procedures should only be performed after testing the patient for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the surgical team must wear full personal protective equipment to prevent aerosol exposure.

Collateral damage: Corneal injury due to mask use during the COVID-19 pandemic - A case series

Though masks are the best shield against COVID?19, they can be a source of discomfort and ocular side effects. We discuss three cases of corneal injury due to mask use. Three patients, who were healthcare workers, presented with discomfort, photophobia, and pain in the eyes. While adjusting the mask, they had an ocular injury. There were multiple superficial linear abrasions in the eyes. They recovered with treatment. Though masks are imperative during the COVID?19 pandemic, it is important to be aware of a possible mask injury.

Prática do uso de máscaras no contexto da pandemia da COVID-19: um estudo transversal / Face mask use in the COVID-19 pandemic: a cross-sectional study

OBJETIVO: Investigar o uso de máscaras entre a população do estado do Rio de Janeiro, durante a pandemia da COVID-19. MÉTODO: Trata-se de um estudo transversal online. A coleta de dados ocorreu via redes sociais e utilizou-se um formulário de informações gerais e a versão para o Português do Brasil da Face Mask Use Scale. Os testes Mann-Whitney e Kruskal Wallis foram utilizados para comparação dos escores. Os aspectos éticos foram contemplados. RESULTADOS: Participaram 1.783 (100%) indivíduos. O escore obtido foi de 18,2 (DP=8,2), com itens variando entre 6,0 e 30 evidenciando que a prática do uso de máscaras foi de 60,6%. Ao avaliar a autoproteção, obteve-se 9,5 (DP=4,0) e a proteção do outro 8,7 (DP=4,6), variando entre 3,0 e 15,0. CONCLUSÃO: A prática do uso das máscaras foi negligenciada por parte da população deste estudo, sendo melhor sua utilização para a autoproteção do que para a proteção do outro.

OBJECTIVE: This study aimed to investigate face mask use among the population of the state of Rio de Janeiro during the COVID-19 pandemic. METHOD: This was an online cross-sectional study. Data were collected via social media using an online form to gather general information about the participants and administering the Brazilian Portuguese version of the Face Mask Use Scale. Mann-Whitney and Kruskal Wallis tests were used to compare the scores. All ethical aspects were considered. RESULTS: 1,783 (100%) individuals participated. The mean score was 18.2 (SD=8.2), with items ranging between 6.0 and 30, placing the practice of mask use at 60.6%. When evaluating self-protection, the mean score was 9.5 (SD=4.0), and protection of others, 8.7 (SD=4.6), ranging between 3.0 and 15.0. CONCLUSION: The practice of wearing face masks was neglected by the population of this study, and their use was geared more at self-protection than at the protection of others.